• 한국호스피스완화의료학회:학술대회논문집
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• 2004.07a
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• pp.100-102
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• 2004

Under the current medical system, a terminal patient and his/her family who are neglected inevitably face various aspects of crises including not only physical, but also psychological, social, economic, spiritual and legal problems. Nurses often look after many terminal patents with these types of complicated problems. Therefore, educating the nurses who will take care of such patents would greatly reduce stress so the patents end could their lives in peace and without losing their dignity. This research is a quasi experimental study of nonequivalent control group. A pretest-posttest design where a basic education program is developed for nurses, who frequently treat terminal patents, to understand the importance of the role of hospice and to apply their understandings to treat terminal lancer patents. A sample of the nurses were taken from those who were working in general wards at two general hospitals in Seoul during October, 2003${\sim}$December 2003. The study was composed of 46 experimental group and 43 control group. A basic hospice education program was developed by taking emphasized and overlapping parts from advanced practice hospice nurses education course, short-term education course, an extensive literature survey and by consulting three professionals as well. With the group of 5 professors with vast experiences in oncolgy, 5 nursing administrator, 3 nursing practitioner, the tentative first version of the program was developed and reviewed. Afterwards, by utilizing person to person interviews with 2 head nurses experienced with terminal patients, 1 nurse in charge of hospice, 1 nurse on the contents of the program, and a person to person rating on the educating medium by a nurse were performed. The final version of a basic education program was developed after the second revision. The hospice basic education program consists of introduction to hospice, hospice and commucation, management of pain for terminal cancer patients, physical management for terminal cancer patients, socio-psycological caring of terminal cancer patients and management of death and separation. Total education time was four hours organized into 50 minutes of instruction and 10 minutes of break. $Powerpoint^{(R)}$ software was used as the education medium. As research tools, "Knowledge on Hospice" was developed by the author after receiving a review from one expert. "Attitude of Hospice Nursing" was revised Kim(2001)'s attitude measuring tool which was based on Wang(1998), Kwon(1989), Park and Sung(1991)'s tool. "Liability on nursing terminal patients" was used as developed by Zarits(1980) and Mongomory(1985) translated by Lee(1985). For collecting data, preliminary investigation prior to 1 week of the hospice basic education program and post-investigations after 1 week and 4 weeks of the education were carried out for the nurses at a general ward who understood and agreed on the purpose of the program. Collected data were analyzed throughout t-test, $x^2-test$, Manova test and Bonferroni correction in $SAS^{(R)}$ program. The summary of the investigation is as follows: Hypothesis 1: "Educated experimental group would possess more knowledge on hospice compared to the un-educated control group" was supported after 1 (F=12.14, p=.00) and 4 (F=5.3, p=.02) weeks of education. Hypothesis 2: "Educated experimental group would take a positive attitude toward hospice nursing compared to the un-educated control group" was supported after 1(F=3.92, p=.05) and 4(F=5.05, p=.02) weeks of education. Hypothesis 3: "Educated experimental poop would feel less liability compared to the un-educated control group in nursing terminal cancer patients' was rejected. In this study, it was found that knowledge on hospice was significantly important. By applying hospice basic education programs to nurses, the education program helped nurses to take a positive attitude toward terminal patients. It was, however, seen that the education program had no effect on alleviating liability in nursing terminal patients. Therefore, it is expected that this educational program would help hospices and nurses at general wards to understand the concept and the role of hospice so that terminal patents, now neglected under current medical system, would be able to end their lives in peace.

• Journal of Hospice and Palliative Care
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• v.22 no.2
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• pp.87-99
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• 2019

Purpose: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. Methods: Mixed methods were used to survey ICU nurses at a university hospital. Quantitative data (N=106) were collected through a questionnaire and analyzed using an independent samples t-test, ANOVA, Mann-Whitney U test and $Scheff{\acute{e}}$ test. Qualitative data (N=19) were collected through focus group interviews and analyzed through qualitative content analysis. Results: The mean score on the difficulty of EOLC was 3.41 out of 5. The education needs derived from the qualitative analysis was categorized into four themes: 1) guidelines on professional EOLC, 2) spiritual care, 3) a program to take care of feelings of patients, families and nurses, and 4) activities to think about death. Conclusion: This study confirmed that ICU nurses were experiencing an extreme difficulty in providing EOLC. In addition, a qualitative analysis confirmed that they needed an EOL nursing program. To mitigate the difficulties experienced by nurses involved in EOLC, there is an urgent need to develop an education program for EOLC tailored to nurses' needs.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.80-89
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• 2013

Purpose: We investigated how intensive care unit (ICU) nurses understand the meaning of death, death anxiety, death concern and respect for life. Methods: From November 2009 through February 2010, a survey was conducted on 230 nurses working at the ICU of 10 general hospitals located in Seoul and Gyeonggi province. Participants were asked to answer a questionnaire consisted of 67 questions under four categories of the meaning of death, death anxiety, death concern and respect for life. Results: Participants scored 4.27 points on their understanding of the meaning of death, 4.43 on death anxiety, 4.12 on death concern and 4.18 on respect for life. Participants' meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' positive meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' negative meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' death anxiety was positively correlated with death concern and negatively with respect for life. Participants' death concern was negatively correlated with respect for life. Conclusion: Compared with nurses who served at ICU for a long time, nurses with less ICU experience scored lower on the meaning of death and respect for life, while they presented high anxiety and concern about death. A training course may help nurses develop their view on the meaning of death, which in turn would enhance their performance in caring dying patients.

• Journal of Hospice and Palliative Care
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• v.2 no.1
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• pp.7-15
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• 1999

This survey was designed to evaluate knowledge and attitudes of physicians and nurses toward cancer pain management in South Korea and to compare physicians' knowledge and attitudes with nurses' Ninety-nine physicians and 152 nurses working at four major institutions in South Korea were included for the study. With the 30 items of the knowledge with true and false answers about cancer pain such as pain assessment(6 items), pharmacokinetics of opioids(8 items), analgesics classification(11 items), and drug administration(5 items), total score of knowledge answered by physicians was 21.40, which was not significantly higher than 20.87 answered by nurses. Rates of the correct answer were more than 70% in both physicians and nurses. Physicians were more knowledgeable in pharmacokinetics and analgesics classification than nurses, while nurses higher only in pain assessment than physicians. Since physicians and nurses could not effectively manage the cancer pain because of inappropriate knowledge, it is important to provide intensive education to physicians and nurses about cancer pain management.

• Journal of Hospice and Palliative Care
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• v.14 no.1
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• pp.20-27
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• 2011

Purpose: The purpose of this study was to investigate the effects of Death Education Program which had been provided to family caregivers of disabled individuals. A single group pretest-posttest design was employed for this study, which was conducted at a community rehabilitation center located in Ulsan, South Korea. Methods: Death Education Program was conducted for 16 family caregivers of disabled individuals who agreed to participate in this study. A 2.5-hour session was conducted once a week for 10 weeks. To investigate the effects of the education program, structured questionnaires, which assessed the patients and their family member's conceptions on the meaning of life, and their resilience, burden, and attitude towards death, were administered before and after the program. Results: The subjects' conception of the meaning of life and resilience did not significantly change. The median scores for the burden of family caregivers declined, while those for the subjects' attitude towards death increased, after attending the education program. Conclusion: The findings showed that Death Education Program has an affirmative effect on the burden of family caregivers of disabled individuals and their attitude towards death.

• Journal of Hospice and Palliative Care
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• v.14 no.4
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• pp.204-211
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• 2011

Purpose: This study used a nonequivalent control group pre-post test design to analyze how a death preparation education program helps middle-aged adults deal with life and death anxiety. Methods: We studied 83 adults at the age of 40 to 65 years. An experimental group of 38 people participated in the death preparation education, and a control group of 45 people did not. The death preparation program comprising four sections was given for four hours per week, and the program ran for 11 weeks. Data were analyzed by descriptive statistics, t-test, ${\chi}^2$ test, Fisher's exact test, and ANCOVA using SPSS version 17.0. Results: The death anxiety score of the experimental group was significantly lower than that of the control group (P<0.000). The quality of life did not show significant difference between the experimental and control groups (P=0.188). Conclusion: It was confirmed that the death preparation education program is effective in alleviating death anxiety. Although the program was confirmed as a necessity for the middle-aged adults, repeated observations with a wider range of experimental group is needed to collect objective and solid data. Death preparation education for middle-aged adults is expected to be more widely provided, starting from local health facilities.

• Korean Journal of Hospice Care
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• v.8 no.1
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• pp.13-28
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• 2008

Purpose: This paper aims to examine the subjective structures and types of school age children's perception of death through an investigative study on their perception of death in order to provide a basic material for them to understand death, and develop and carry out an effective death education program. Methods: The study method used the Q Methodology which can investigate the subjective structures and types of school age children's perception of death. For Q-population, 20 school age children were used as subjects for neutral interviews and open surveys, and through documentary research, a total of 132 statements were collected, For Q-samples, 23 statements (Q-samples) were derived through a non-structural method. P-samples were 31 school age children (8-13 year olds), Q-sorting was carried out using Q-cards, and the collected data was analyzed using the PC QUANL program. Results: As a result of the study, children's perception of death was divided into five types. The first type was functional type, characterized by prominent subjective perception regarding the elements of death, such as non-reversibility, universality, non-functionality, and causality. The second was after-life type, characterized by a strong, focus on life after death in one's perception of death, and it included children with Christian background and those who had experienced death in their immediate family. The third was religious type, characterized by a strong belief in being able to still watch over one's family and friends after one's death, resulting in a positive faith in the after-life. The fourth was fearful type, characterized by a deeper fear of death in comparison to other types. The fifth was realistic type, characterized by a strong and positive assent to the perception of good death. Conclusion: The significance of the results of this paper's study to Nursing is as follows. In terms of understanding the subjectivity of school age children's perception of death in nursing practice, and understanding the compositional elements of death presented with strong emphasis in existing literature and studies, the results will expand these understandings and allow us to understand the level of perception in school age children regarding the definition of death, after-life, and good death, be utilized as useful material in developing an effective death education program for them according to their type characteristics, and become the fertilizer for enabling the children to live a proper life and preventing the tendency to make light of death that occur in adolescence and the spread of suicides. In terms of nursing theory, the description and examination of the subjective structures and the characteristics of the different, types of school age children's perception of death can be utilized as useful material for building a model of school age children's perception of death, and be further used for teaching respect for life. In terms of nursing research, the results can contribute to research describing the effects of nursing intervention strategies and developing tools for providing psychosocial nursing in terms of giving school age children a positive perception of death according to their types as well respect for life.

• Korean Journal of Hospice Care
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• v.8 no.1
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• pp.1-12
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• 2008

Perpose: The purpose of this study was to investigate the perception of death between Korean and Chinese nursing students. And it will help develop curriculum for preparing death, the quality of hospice care, as well as nursing education and practice. Methods: Data was collected from 492 nursing students participated(248 Korean and 244 Chinese) by questionnaire designed for examining Death Orientation (Thorson & Powell, 1988). They were analyzed using Cronbach's Alpha coefficients, factor analysis, t-test, ANOVA and regression analysis (SPSS; win 12.0 version) Results: More than half of the Korean nursing students followed a religion (58.5%) while the majority of Chinese nursing students did not follow a religion (93.9%). In the view of the afterlife, nursing students in China had two views. 'I really don't know what happens after a person dies (30.3%)' and ‘There is no afterlife and death is the end (29.5%)’. On the other hand the Korean nursing students’ answer were, 'After dying, a person goes to heaven or hell (27.3%)' and 'I really don't know what happens after a person dies. (22.9%)' The study also found that the average of 25 items in Death Orientation is 2.36points of nursing students in Korea and 2.50points of nursing students in China. This means that the concern, anxiety and fear were of the middle level for the Chinese Students and were higher than Korean students (t=3.51, p=.000). In the low factor of death orientation, those in Korea had higher 'anxiety of burden to family' than those in China (t=-3.50, p=.001). The nursing students in China had higher 'anxiety of the unknown (t=4.96, p=.000)', 'fear of suffering (t=6.88, p=.000), 'fear of extinction body and life (t=5.20, p=.000), 'fear of lost self-control(t=2.12, p=.034)', and 'anxiety of future existence and nonexistence (t=2.33, p=.020)' than those in Korea. There was no statistically significant difference for the 'concern of body and fear of identity lost' category. The death orientation of Korean nursing students had statistically significant differences according to age (t=3.20, p=.002), religion (t=2.56, p=.011), and afterlife (F=4.64, p=.000). The contribution of Death Orientation had a statistically significant difference, the afterlife variable (0.735, p=0.001). The death orientation of Chinese nursing students did not have any statistically significant differences. Conclusion: In conclusion, there were differences in death orientation between Korean and Chinese nursing students. In particular, those who believed in afterlife showed acceptance of death. The results of this study suggest that nursing curricula should include education program on death and spiritual nursing. Additional studies are needed to establish death education in China with careful considerations on Chinese policies, cultures and social systems.

• Journal of Hospice and Palliative Care
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• v.18 no.1
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• pp.25-34
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• 2015

Purpose: This study is to find relationship between cancer patient's spiritual health and the level of their anxiety and pain. Methods: From April 27 through May 11, 2012, a survey was conducted with 167 cancer patients hospitalized at a university hospital in Busan. Spiritual health was measured by the Spiritual Health Inventory developed by Highfield (1992). The instrument for anxiety measurement was the State-Trait Anxiety Inventory by Spielberger (1975) and that for pain was the Visual Analogue Scale (2009). The association between patients' characteristics and spiritual health, anxiety or pain degree were analyzed using the ANOVA test. The interrelationship between spiritual health, anxiety and pain was analyzed using Pearson's correlation coefficients. Results: The patients exhibited a moderate degree of spiritual health and anxiety and a mild level of pain. Patients' spiritual health significantly differed by their religion, education, monthly income of the family, illness conditions, physical conditions, metastasis, daily living and support. Their anxiety level was significantly different according to age, religion, education, illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. Significant differences were also found in the level of pain according to illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. We found a moderately negative correlation between spiritual health and anxiety. Anxiety and pain showed a positive correlation, and spiritual health and pain exhibited a negative correlation. Conclusion: To help cancer patients to manage their spiritual health, anxiety and pain, a program should be developed considering the primary factors discussed in this study.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.142-150
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• 2014

Purpose: This study was to identify the attitude of Korean HIV (Human Immunodeficiency Virus)-positive men toward death. Methods: A Q-methodology was performed with 20 HIV-positive male individuals. Participants were asked to select and answer questions among a set of 40 Q-statements using a 9-point scale. The collected data were analyzed using the PC QUANL program. Results: Participants' attitudes toward death were categorized into four types. Type I was characterized by respect for life, type II by reality orientation, type III by pain evasion and type IV religious beliefs. Conclusion: It is necessary to develop an assessment tool and an intervention program for HIV-positive individuals.